DURBAN, South Africa—Ronald Louw was a human-rights lawyer and professor at the University of KwaZulu-Natal, the South African province that’s one of the most HIV-affected regions of the world, so he must have known about the dangers of the virus. In April 2005, he was taking care of his mother, who had been diagnosed with cancer, when he noticed he had a cough that would not go away. He went to a doctor, who treated him with antibiotics.
Four weeks later, he got even worse, fighting a fever, night sweats, and disorientation, as his friend and fellow activist Zackie Achmat recounted later in a journal article. It was only then that Louw finally went in for an HIV test. He was positive.
A month later, doctors told him his persistent cough was actually tuberculosis—one of the leading causes of death for people with HIV. Three days later, Louw was dead at the age of 46.
“Smart, educated, and surrounded by friends who understand HIV/AIDS, yet even Louw failed to get tested early,” Achmat wrote later in an op-ed. “He died because he did not get tested early. And, when he discovered his HIV status, his lungs and immune system were destroyed.
Louw’s case provides a stark example of one reason why the HIV epidemic in South Africa remains the largest in the world, even though the country provides antiretroviral treatment to anyone for free. ARVs, which slow down damage to the immune system, are now able to help HIV-positive people live almost a normal life expectancy. But only about half of infected South Africans take ARVs consistently. And not everyone even knows their status: About 14 percent of South African adults who have HIV are not aware of their status.